An Evaluation of Complications in Femoral Arterial Sheaths Maintained Post-Neuroangiographic Procedures

Background: Digital subtraction angiography (DSA) is a frequently used technique in the neuro-diagnosis and treatment of cerebrovascular diseases. The routine use of femoral arterial sheaths (FAS) peri-procedurally has become standard. The maintenance of a FAS post-procedure may be warranted while awaiting the normalization of coagulopathy or to reaccess emergently. We retrospectively reviewed our stroke dataset to evaluate for complications associated with the prolonged use of FAS post-procedure. Methods: A retrospective chart review was performed over a five-month period, including adult patients admitted to the neuroscience intensive care unit (NSICU) following a neuro-endovascular procedure at a tertiary healthcare facility. The patients' age and sex along with catheter size, duration of sheath placement, coagulation status, usage of heparinized-saline, reuse of FAS for angiographic interventions, and closure technique employed when sheath was removed were recorded. FAS were maintained and evaluated by the neurocritical care team for vascular complications according to protocols. Furthermore, patients were categorized as delayed extubation when they remained intubated post-procedure. A spontaneous breathing trial was performed once FAS could be removed following evaluation. Data were expressed with descriptive statistics. Results: One hundred and seventy-eight neuro-endovascular procedures were reviewed. Fourteen patients in which the sheaths were left in place for a prolonged period of time after the procedure were identified with seven (50%) having complications. The most common complication was delayed extubation, which was noted in all seven of the patients with complications. Bleeding complications were noted in four (28.6%). None had thromboembolic complications. Only one FAS was reaccessed for the evaluation of vasospasm and the introduction of intra-arterial verapamil. There was a linear increase in complications with the duration the catheter remained in place after the procedure. Conclusion: The practice of keeping FAS in for a prolonged period of time following procedures should be evaluated given the association with direct and indirect complications and minimal need to reaccess the catheter after the procedure.